• Supervisor Quality Auditing

    AmeriHealth Caritas (Philadelphia, PA)


    Position Summary:

    The Quality Auditing Supervisor is responsible for overseeing the day-to-day operations of the Operations Quality Analyst team within the Community Health Choices program. This role ensures compliance with quality standards, regulatory requirements, and service level agreements (SLAs) while driving process improvements and team development.

    Key Responsibilities

    + Supervise and provide coaching to Quality Analysts on production, quality, and audit resolution.

    + Coordinate work distribution and monitor inventory to ensure timely completion of quality monitoring activities.

    + Serve as a resource for escalated or complex issues, process/system challenges, and regulatory updates.

    + Manage audit disputes through all levels of appeals.

    + Collaborate with Service Coordination leadership and training teams to identify process improvement opportunities.

    + Escalate trends and ensure corrective actions to prevent recurrence of issues.

    + Support automation initiatives within quality monitoring processes.

    + Identify and mentor key team contributors for professional development.

    Qualifications

    + Education: Bachelor’s degree preferred.

    + Experience: Minimum 3 years of relevant experience in healthcare, quality assurance, appeals, or grievances.

    + Previous supervisory experience preferred.

    + Technical Skills: Proficiency in Microsoft Word, PowerPoint, Excel, Access, and Project.

    + Preferred Knowledge: Familiarity with Member Appeals, Claims, Call Center operations, Member Enrollment, Provider Data, and/or Credentialing.

    Skills & Competencies

    + Strong leadership and team management skills.

    + Excellent problem-solving and decision-making abilities.

    + Ability to manage multiple priorities and meet deadlines.

    + Effective communication and interpersonal skills.

     

    Our Comprehensive Benefits Package

     

    Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.

     

    **Why Join Us:** Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.

     

    About AmeriHealth Caritas

     

    Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com

    As a company, we support internal diversity through:

    Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.